Enquiry From
Name:
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Surname:
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Phone:
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Email:
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Date of Birth:
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Age:
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Weight & Height:
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Have you ever worked with a Coach or Personal Trainer before?:
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Yes
No
What made you reach out?:
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What are your past experiences with health & nutrition?:
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I have never really paid attention to my health and nutrition
I have some knowledge about healthy eating and exercise
I have followed specific diets or exercise plans in the past
I have been on a weight loss or muscle building journey before
Why do you feel it's important for you to start this journey?:
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How do you TRUELY feel about your appearance, health, mind & body?:
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What are your current top 3 goals (short term)?:
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What are your current top 3 goals (long term)?:
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Why do you want to achieve these goals?:
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What do you feel you need to achieve your goals? What do you see as the first step to accomplishing your goal?:
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What positive things do you feel will happen if you accomplish what your trying to achieve?:
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How will you know if you have achieved your desired outcome?:
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Currently how would you rate your happiness on a scale of ten?:
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This field is required
What things from your daily life make you happy?:
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What type of life do you envision for yourself?:
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What is your definition of success? & How do you think you will achieve SUCCESS?:
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What are your biggest fears, stressors & obstacles?:
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What are 5 things that would make the biggest difference in your life right now?:
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What Services are you most interested in?:
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Premium 1:1 Lifestyle Coaching
Nutrition Only Coaching
Training Only Coaching
F2F PT
Both (Coaching & F2F PT)
PDF Options: Nutrition &/or Training
Not sure yet
If you had to be specific about your goals, what would be your highest priority?:
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Lose Body fat %
Build Muscle Mass
Develop a better lifestyle
Improve Nutrition
Build Confidence
Learn Form & Technique
Rate this goal (1 not important - 10 very important) - Weight Loss:
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This field is required
Rate this goal (1 not important - 10 very important) - Muscle Gain:
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This field is required
Rate this goal (1 not important - 10 very important) - Lifestyle Balance:
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This field is required
Rate this goal (1 not important - 10 very important) - Fitness Level ~ Strength Development, Endurance etc:
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This field is required
What does the most important above 'goal' mean to you? Ie if your most important goal was building muscle what does that mean - big biceps? definition in your muscles?:
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Have you achieved these goals in the past? If so tell me what has changed since you were here & how did you achieve this goal previously?:
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